Background The benefit of myocardial perfusion imaging (MPI) over exercise ECG stress testing alone is unclear in individuals attaining a workload of ≥10 METS. The purpose of this prospective study is to determine mortality and nonfatal cardiac events in patients at either intermediate pretest risk for CAD or patients with known CAD, achieving ≥10 METS regardless of peak exercise heart rate. The authors previously reported a low prevalence of significant ischemia in this patient cohort. Methods Baseline characteristics, ECG stress test findings, and perfusion and function results from quantitative gated 99mTc-SPECT MPI were compared by achievement of a maximum age-predicted heart rate ≥85% in 509 consecutive patients who reached ≥10 METS. Events including all-cause and cardiac mortality, non-fatal myocardial infarction (MI), and late revascularization (>4 weeks after MPI) were prospectively collected. Results Of the 509 patients achieving ≥10 METS, follow-up for mortality was obtained in 463 (91%). Those lost to follow-up were older and had higher rates of tobacco use. The prevalences of CAD risk factors, prior known CAD, and MPI abnormalities were higher for the 68 patients failing to reach 85% of their target heart rate. The rate of ≥10% left-ventricular (LV) ischemia by MPI remained very low irrespective of attained heart rate (0.6% (3/463)). Six (1.2%) had an LVEF < 40%. Death occurred in 12 (2.6%) patients, one of which was classified as cardiac (0.1%/year). The other 11 deaths were related to cancer. Additionally, there were three nonfatal MIs (0.7 %) and one late revascularization (0.2%). Only one of these patients had any ischemia on MPI. No cardiac event patient had exercise ST depression or ≥5% LV ischemia. Conclusions Thus, patients at intermediate risk for CAD or known CAD achieving ≥10 METS have a very low prevalence of ≥10% LV ischemia and very low rates of cardiac mortality, nonfatal MI, and late revascularization, irrespective of heart rate achieved. Cardiac events did not correlate with abnormalities on the index MPI study. These results suggest that patients who attain ≥10 METS during exercise stress have an excellent prognosis over an intermediate term of follow-up, regardless of peak exercise heart rate achieved. The added value of MPI to standard exercise ECG testing in this population is questionable.
Background Open trigger finger release is generally considered a simple low-risk procedure. Reported complication rates vary widely from 1 to 43 %, mostly based on small studies. Our goal was to determine the incidence of complications in a large consecutive series, while also identifying potential risk factors. Methods All open trigger finger releases performed from 2006 to 2009 by four fellowship-trained hand surgeons at a single institution were retrospectively reviewed. There were 795 digits released in 543 patients. Complications were defined as signs or symptoms requiring further treatment and/or considered unresolved by 1 month postoperatively. Complications requiring operative intervention were regarded as major. Multivariable analysis was performed to determine possible risk factors for complications. Results There were 95 documented complications among 795 digits (12 %). The most common complications involved persistent pain, stiffness, or swelling, persistent or recurrent triggering, or superficial infection. Most were treated nonoperatively with observation, therapy, steroid injection, or oral antibiotics. There were 19 reoperations (2.4 %), mostly including revision release, tenosynovectomy, and irrigation and debridement. Male gender, sedation, and general anesthesia were independently associated with complications, while age, diabetes, hypothyroidism, recent injection, and concurrent procedures were not associated.Conclusions Open trigger finger release is generally a lowrisk procedure, although there is potential for complications, some requiring reoperation. Male gender, sedation, and general anesthesia may be associated with greater risk. Surgeons should be careful to thoroughly discuss the risk of both major and minor complications when counseling patients.
» Surfing is safe: the risk of injury ranges from 0.26 to 0.90 injuries per surfer per year, 0.06 to 3.5 injuries per 1,000 days of surfing, and 1.1 to 13.0 injuries per 1,000 hours of surfing.» The most common acute surfing injuries are lacerations, contusions, and sprains; the head and the neck as well as the lower extremities are the locations that are affected most.» The most common mechanism of injury is striking a surfer’s own board or that of another surfer.» A pathology that is unique to surfers is surfer’s myelopathy; bites and/or stings by sea life and infections caused by marine life also occur in surfers.
Introduction Positioning of implant components for total hip arthroplasty (THA) is important for polyethylene liner wear, prosthesis joint stability, and range of motion. The introduction of fluoroscopy for the direct anterior approach has been shown to improve physician accuracy for component positioning. Few studies compare the use of intraoperative fluoroscopy for THA component positioning in posterior THA. The purpose of this project is to retrospectively evaluate the effect of intraoperative fluoroscopy on component positioning for THA using posterior and direct anterior approach (DAA). Materials and Methods A retrospective review of postoperative weight-bearing X-ray films of THAs was performed over a 2-year period where a single fellowship–trained total joint surgeon introduced direct anterior approach into his practice while expanding the intraoperative use of fluoroscopy for all THA procedures, regardless of approach. Component position was evaluated through radiographic measurement of acetabular cup inclination (goal of 40 degrees), limb length discrepancy (goal of 0 mm), and femoral component offset difference (goal of 0 mm). Radiographic analysis was performed by two independent providers. Statistical analysis was performed using Student’s t-tests. Results A total of 107 patients with an average age of 62 years were identified during the 2-year period surrounding the THA practice change, adding fluoroscopy to posterior and DAA THA. Three cohorts were identified: cohort A: 44 patients who underwent posterior THAs without the use of intraoperative fluoroscopy, cohort B: 35 patients who underwent direct anterior approach THAs with the use of intraoperative fluoroscopy, and cohort C: 18 patients who underwent posterior THAs with the use of intraoperative fluoroscopy. The use of intraoperative fluoroscopy for the posterior approach versus unguided posterior approach increased accuracy of both cup inclination (44 degrees vs 50 degrees, P < .05) and femoral offset (4 mm vs 7 mm, P < .05). A comparison of DAA with fluoroscopy versus posterior approach without fluoroscopy showed improvement in cup inclination (48 degrees vs 50 degrees, P < .05). Fluoroscopy with posterior approach versus fluoroscopy with DAA was found to have improved cup inclination (44 degrees vs 48 degrees, P < .05). Conclusion Intraoperative use of fluoroscopy can improve component positioning for posterior THA.
The Achilles tendon is a common site of anatomical injury among athletes and those participating in recreational sporting activities. Acute Achilles tendon ruptures are often misdiagnosed as a sprained ankle and are more common in the male population. Mechanism of injury is often a noncontact injury, resulting from sudden forced plantar flexion or violent dorsiflexion in a plantar flexed foot. Delays in diagnosis and treatment may complicate the clinical outcome. Because findings may be subtle on history and physical examination, the use of readily available adjunctive studies is important for practitioners. One method is the analysis of Kager's triangle on lateral ankle radiographs. Obscuration of Kager's triangle has been described as a radiographic indicator of Achilles tendon rupture, but the sensitivity and specificity of this finding have been poorly reported. [ Orthopedics . 2020; 43(2): e91–e94.]
Background: Osteogenesis imperfecta (OI) is an uncommon disorder frequently associated with spinal deformity. Relatively little is known about the effect this disorder has on the outcomes of spinal fusion for spinal deformity. The purpose of this study was to evaluate the differences in treatment and outcomes of this unique patient population. Methods: The nationwide HCUP Kids’ Inpatient Database (KID) from 2000 to 2012 was queried to identify patients with OI who underwent spinal fusion surgery for treatment of scoliosis. Demographic variables were obtained along with length of stay, mortality, length of fusion, transfusion rates, and hospital charges. Control data consisting of pediatric patients who underwent spinal fusion for adolescent idiopathic scoliosis (AIS) were acquired and compared. Results: A total of 60 patients (average age of 13.2 yr) with OI underwent spinal fusion during the study period. Of the patients who underwent fusions, 63.3% had involvement of nine or more vertebrae, which was significantly higher than patients with AIS (35.7%: P<0.001). Patients with OI also had a higher average length of stay (8.1 vs. 5.7 days: P<0.001). Nearly half of the patients with OI required blood transfusions, which was significantly more than patients with AIS (43.3% vs. 30.4%; P=0.029). Patients with OI also experienced significantly higher hospital charges versus controls ($173,652 vs. $46,953; P<0.0001). Conclusions: Spinal deformity surgery in patients with OI is a technically demanding procedure with high morbidity and high cost. In this nationwide series, a higher rate of blood transfusions, longer hospital stays, and significantly higher hospital charges were identified compared to patients with AIS. Level of Evidence: Level III, Retrospective comparative cohort study
Purpose: Predynamic instability in scapholunate (SL) ligament tears is a source of wrist pain. Despite this, identifying the proper treatment remains elusive. The purpose of this study was to evaluate return to activity after wrist arthroscopic electrothermal shrinkage for treatment of SL predynamic instability. Methods: Patients enrolled in an ongoing quality assurance project of wrist arthroscopic electrothermal shrinkage surgery for treatment of SL predynamic instability in an active duty military patient cohort were included in this retrospective review. Primary outcomes at a 2-year minimum follow-up were the rate of return to full duty and the rate of return to push-up activities. Results: This study identified 14 active duty patients who met inclusion criteria, mean age 29 years. Six were male and 9 of 14 had concomitant arthroscopic occult dorsal ganglion cyst removal at the time of the index surgery. The severity of SL instability was staged using the Geissler classification; the cohort distribution for stages I, II, and III was 3 patients, 10 patients, and 1 patient, respectively. At 2-year followup, the return to duty rate was 12 out of 14 and the return to push-ups activity rate was 11 out of 14. Pain with activities by visual analog scale was reduced from 7.1 to 1.4. Conclusions: Prior studies demonstrated SL ligament electrothermal shrinkage as a useful modality for pain relief. Our study suggests that this treatment may also aid in return to duty and push-up activities for young active patients. Type of study/level of evidence: Therapeutic IV.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.